Sugarcane (Saccharum officinarum L.) is a high-value cash crop in Pakistan, making the country the fifth largest producer globally, with an annual production of approximately 67 million tons of cane. This chapter offers an overview of advancements in sugarcane breeding, the development of germplasm, and associated biotechnology within Pakistan. To date, variety development has primarily focused on the selection of imported seeds and clones. Although this approach has yielded success, further enhancements are necessary. This review delineates various breeding strategies utilized by research institutes and sugar mills, encompassing the historical context and contemporary methodologies of breeding programs, alongside significant germplasm development initiatives at both national and international scales. Genetically modified sugarcane varieties, such as CABB-HTS (herbicide-tolerant transgenic sugarcane) and CABB-IRS (insect-resistant transgenic sugarcane) have been approved for cultivation. It is concluded that full-scale breeding programs should be established to develop new sugarcane varieties that offer higher economic value for sugar and other products at a lower cost than existing commercial varieties.